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General practice may have 'failed as a profession', but we have succeeded as a charity

An anonymous GP in Wales reflects on Professor Steve Field’s comments

I have had a little think about Professor Steve Field’s pronouncement that we’ve failed as a profession, and what exactly it might mean, and have come up with a slightly different (and perhaps eccentric) take on the whole affair.

Obviously Professor Field has singled out general practice, not doctors in general, so what is the difference?

Let’s compare a few other professions. Supposedly the oldest profession, prostitution, has (apparently) hoards of people thronging to the professionals proffering huge amounts of money for services. Lawyers have hoards of people thronging to proffer them large amounts of money for services. Private medical practitioners (and even ‘alternative practitioners’) have hoards willing to pay huge amounts of money for services (including some that GPs mostly think are unneccessary).

So, in fact, Professor Field’s pronouncement is high praise indeed

Then we come to GPs: have we thrived as a profession? Do we have hoards coming showering us with money? Let’s go through the potential hoards:

 - Patients - no, and if they did, we would be required to refuse it and inform the GMC.

 - LHBs/PCTs - no, indeed, a recent offer of money for referrals, we were urged by RCGP to decline as it was ‘immoral’.

 - Drug companies - well, there is another one we have refused to accept for so long, I don’t think they bother any more.

But we do have many agencies coming to us asking us to do their work for free. And we do have hoards of poorly patients coming to us for free treatment, authorisation of hand-outs, certifications, etc. What do they think we are, a charity?

This is not just a frivolous rhetorical question or dismissive offensive remark. General practice may have failed as a profession, but it has succeeded as a charity. Unfortunately, whilst both may have high ideals and standards, the two are actually, very different in certain basic qualities, that make them probably mutually incompatible.

So, in fact, Professor Field’s pronouncement is high praise indeed. It is just that for the many of us nowadays who are working-class breadwinners, it is harder to maintain the charity ideals if we do not have pre-existent financial ‘independence’ to fall back on to ensure the bills and staff salaries are paid at the end of the month.


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Readers' comments (7)

  • Well said!

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  • This adds little to the debate.

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  • I disagree 11:05.

    The suggestion adds focus to what we really want to be. Do we want to be paid professionals who are rewarded in concrete terms for the complex work we do? Or do we want to be poorly paid but receive enormous satisfaction from a noble task completed well? The question strikes to the essence of the NHS religion to which we have become both devotees, priests and succor to. We have come to see our ontology as bound inextricably with the NHS.

    The comments of Dr Field pose another question - if we have failed, what have we failed at?
    - Quality (probably the aim of his comment in context)? Well, the CQC's stats show otherwise.
    - Financially - arguably, yes, although the failure rate of practices is probably no greater than in any other business sector.
    - Preserving the NHS - This might well be the view of Dr Field, but I would argue it was never our job to do this.
    - Our Patients - Yes and no. We have given them all we could. But in doing so we have failed them in that we have trained them to be unsustainably needy.

    If 'first do no harm' is our start point, we must decide whether the status quo or radical change will do least harm - arguably 'no harm' is unachievable - we can only hope to do the least harm to the least number (utilitarianism).

    I smiled at a scene from the comdey Catastrophe the other day. The couple argue about whether he would put her air mask on first in a plane crash, and he says 'no, because you're told not to - put your own on first so you are conscious to help others'. Medics, take note.

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  • Who can afford to be a full time charity?

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  • If I wanted to do charity I wouldn't have went to med school

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  • Why wasn't this article given the same promenence on the website as Prof Field's or Nick Summertons? Was it not provocative enough towards readers?

    Well said Dr Anon from Wales.
    Ditch the contract comrades!

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